The purpose of the study is to relate outcome and causes of death to events or risk factors measured in life among Pima Indian residents of the Gila River Indian Community, particularly in relation to diabetes and its complications, cardiovascular diseases and gallbladder disease. The causes of death and postmortem characteristics of Pima Indians of the Gila River Indian Community are investigated. Death certificates are obtained on all members of the Gila River Indian Community who have taken part in the ongoing longitudinal studies of diabetes and its complications. Postmortem examination results and all available medical records pertaining to the dececdents are reviewed to ascertain conditions present at the time of death and ascertain the underlying and contributory causes of death as precisely as possible. The records are reviewed in a standardized way for evidence of the complications of diabetes, vascular disease, neoplasia and other conditions. The data are used to determine the causes of death and incidence of complications associated with diabetes and other conditions identified initially during life by the longitudinal epidemiologic studies in the population. Detailed review of causes of death from 1965-1998 has been completed and those from 1999 to the present time are ongoing. Recently relationships of body mass index and renal insufficiency to death rates and underlying cause of death have been analysed. In addition secular trends in coronary heart disease have been examined.